Typical rate/dosage pitocin after C-Section

  1. We have a new surgeon who is new to doing C-Sections and his Pit order is drastically different from our other surgeon, just wondering if it is a typical rate and dosage. This is not a typo:
    80 units of Pitocin in 500 cc Normal Saline to run at 17 cc/MINUTE, run in the whole bag. This is to be started after cord is clamped.
    Safe? Normal? I dont usualy work OB...
    Jessica
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  2. 16 Comments

  3. by   tntrn
    Our anesthesia people put 10 -20 units in the bag hanging in the OR, depending on how much it in the bag. It's running at a pretty good clip, but it not on a pump at that time.

    In recovery, the next bag will have 20 units of pit, in 1000 cc D5LR and it will run at 150cc/hr.

    If I'm doing the math correctly, your bag will take about 30 minutes to run in, meaning your patient is getting that entire 80 units in 30 minutes. Our bag will run in 20 units in about 6 hours. So it seems like a lot to me.

    Other opinions.
  4. by   JenTheRN
    It seems like waaaaaay too much. We usually have 20 u in a 1000ml bag that runs at 150 an hour. Sometimes faster than that if a uterus is boggy. Why in the world would you need 80 units?
  5. by   ElvishDNP
    Sounds like overkill to me. We give 2L of D5LR with 20u in each 1000ml for a c/s with no problems. If they're bleeding we add an extra 20. I still think we overdo pit postpartum (and intrapartum too if you want my honest opinion).
  6. by   TooterIA
    Thank you for your replies. We also think it is overkill. He did 2 sections this week and on ehte first pt the CRNA never gave it at that rate, Im not sure what she ran it at but it was our more typical 20 units in 1000cc I believe. The surgeon found out later and was PISSED. The 2nd section he yelled at the CRNA and told her to run it at what I wrote above because that is what he wanted. Of course the pt was in massive pain. I believe our OB manager will be looking into it.
    Jessica
  7. by   crissrn27
    We do two units of 20mu per 1000cc after c-sec if no problems. I think they do 150cc/hr in recovery and then they are taken off the pump and second bag runs in gravity over two hours or so. And this from a hospital that way over uses and misuses pitocin, so I would question that surgeons order too.
  8. by   NPinWCH
    All I can say is OUCH!!!

    I attempted a VBAC with my second and after a 2 day pit induction went for a repeat c-section for a 9#14oz girl...well we all know what happens after 2 days of pit and a big baby. Yep, I bleed like a stuck pig in PACU. I had 20 units in my 1000 LR, they started another IV and hung 20 units in 1000 NS, ran both wide open. Blood still running off the cart onto floor, I passed out and woke up to bimanual massage and the surgeon injection 20 more units directly into the myometrium. On my way back to the OR I got methergine and hemabate IM, plus 20units in my next bag, some of which did the trick because the bleeding slowed. (My hgb dropped from 14 to 6).

    Even with the spinal still in place I felt like my uterus was being forced out my vagina!! That much pit is just ridiculous unless there is alot of bleeding going on.
  9. by   Jolie
    No way would I run that much pit in that fast, nor would anesthesia. If the surgeon wants it, let him give it and sign for it.

    Too many risks of complications, not the least of which are fluid overload, and poorly-controlled pain. Even if a patient is hemorrhaging, it is still too much. There are other, more effective drugs that can be used such as hemabate.
  10. by   SmilingBluEyes
    Fluid volume overload anyone?

    This is quite a radical amount.....I can't say I have ever seen it done this aggressively. Remember, pit acts like ADH and will cause these ladies to retain fluids. Since they usually get a LOT for c/sections anyhow, no need to make things worse. We run 30units in 500ml normal saline at 150ml/hr unless bleeding/boggy,then we will run a 250-300 ml bolus and then take it back to 150ml/hr. Usually, we only need to run one bag of pit after the c/section. Rarely, we might run a 2nd, and that will be 20units in 1000ml LR as a rule. Same rate.

    And yes, the cramping you will bring on??? OUWWWIE.

    That much pit should not be necessary. If it is, you have a problem that pit wont' solve.
    Last edit by SmilingBluEyes on Apr 27, '07
  11. by   Mermaid4
    Actually, though I would NOT want to do it, I had an OB guy tell me that in some countries they use up to 100 Units a bag..I haven't personally seen that and hope not to, but I guess in the OB arena, according to this particular OB, who was from the middle east, we're conservative..I say if a little bit works, no problem. Typically we run ten or twenty units for the first bag or two post up depending upon the doc...I have run as much as forty units in a vag pph.....
  12. by   BirthingBabies
    after cord clamp, the crna normall adds 20mu of pit to whatever is left in the LR (if it's 500cc or more) and they usually come back to the room with that bag still hanging... in recovery and for 12 hours post op they get D5LR with 20 pit at 125hr.
  13. by   crysobrn
    I second the "OUCH!!"

    Depending on the doc we use either 10 or 20 in 1000cc LR. Usually they get one or two liters total running at 125cc/h. One of our docs that just retired liked them to get pit in the IV until the IV is d/c'd. He didnt' do a lot of deliveries but he was also one that liked pitocin hung once the babies head was out (for vag deliveries)... I almost always forgot cause the other docs didn't want it til the placenta was delivered.
  14. by   dnellnelson
    Our perinatologist has instituted a new pp pit protocal over the the last year or so. 40 units of pitocin in 500 cc D5LR to run in wide open after a c-section. 30 units in 500 cc D5LR over 30 minutes for SVD. It seems we have seen an increase in our use of misoprostil, hemabate, methergine for PPH. One article I read implied it was not the overall dosage of the pitocin but the length of time it is infused that helps control the bleeding. I have not done an official evidence based lit search but we really have increased our bleeding, I believe by running in more over less time. We'll see.

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